Tumor ablation training opportunities expand

While clinical data supporting the effectiveness of tumor ablation is growing, educational opportunities for physicians who want to learn new techniques or get tips on developing a tumor ablation practice lag behind. Some training is available through CME courses, industry society events, vendor education, and informal arrangements with luminaries, but large-scale, organized training regimens do not yet exist.

Typical tumor ablation training for practicing physicians consists of one- to two-day courses that include a didactic portion and some hands-on time. Many experts say this is enough.

"For many people, this is not rocket science," said William McMullen, an interventional oncology consultant and one of the organizers of the Fire & Ice Tumor Ablation Symposium & Workshops. "To oversimplify, RFA is a combination of taking a biopsy and doing a cauterization--most people feel this is nothing more than directing a needle into a tumor and turning on some heat-based energy. There aren't too many people out there who feel that there's any need for more than that for an interventional radiologist or a surgeon who does a lot of biopsies."

But while most of the major tumor ablation supporters agree that the one- to two-day timeframe is sufficient to get a start at tumor ablation, after that the issue gets murky.

Both the Radiological Society of North America and the Society of Interventional Radiology offer some tumor-ablation training at their conferences, but these sessions are usually short. The practical components tend to be more of show-and-tell than hands-on training, said Hilary Bikowski, director of education for SIR.

"We don't do any hands-on extensive workshops," Bikowski said. "We let the vendors bring in their RF devices and they have about an hour and a half or two hours to show how the equipment works rather than train on the actual technique."

Manufacturers provide their own hands-on training on their devices and give educational grants and sponsorships for outside courses, said Michael LaPrade, director of oncology marketing at Boston Scientific.

Valleylab, Boston Scientific, and RITA Medical, the three major device manufacturers that serve the U.S. market, all offer courses for physicians who use their equipment. Courses can be geared toward the specific knowledge level of an individual physician.

Training for practitioners new to the procedure typically consists of an introduction to the technology and how it works, then plenty of hands-on time with animal models, LaPrade said. Physicians who already have experience with the technique may concentrate on more difficult procedures or case reviews. It's also possible to bring a proctor into an institution or have a practitioner visit another facility to shadow an expert.

Fire & Ice, one of the few independent, comprehensive training programs, first came to the RSNA's attention two years ago. The informal RSNA tumor ablation working group noticed it was receiving a growing number of calls from people in search of training, and decided to offer a program to address that need.

The symposium encompasses more than just the technical aspects of tumor ablation. It also addresses the business behind the procedure, McMullen said. It features presentations on patient care and nursing aspects of tumor ablation, information on anesthesia and pain control, and sessions on reimbursement and building a practice.

"A lot of attendees are customers who are just starting out--they've purchased a system and they've done one or two procedures, but they don't have a business plan, they may not have everyone buying into it, they don't know how to increase the referral patterns, and they don't know how to work as a team," McMullen said.

Despite the existence of these courses and training opportunities, the situation is still not ideal, McMullen said.

"A perfect course would involve a preceptorship," McMullen said. "I don't think there is anything that takes the place of actually being there when a procedure is performed, seeing everything that goes right and goes wrong, and the challenges that occur in between."

So far, there is no organized preceptor program for established physicians, McMullen said. But many tumor ablation experts allow interested physicians to make informal arrangements to shadow them for a limited time.

One such expert is Dr. Damian Dupuy, professor of diagnostic imaging at Brown Medical School in Providence, RI, and a prime mover behind the development of tumor ablation techniques. Interested physicians have traveled to Brown to observe Dupuy performing ablations for a week at a time. McMullen, as the informal keeper of the tumor ablation working group list, said he could place interested practitioners with specialists in the field who may be able to work out a similar arrangement.

A major part of tumor ablation training and education today still comes from the network of tumor ablation researchers and proponents who make up the working group, McMullen said.

"We all call each other," he said. "We all still talk to each other about tricky procedures. That's basically what the tumor ablation working group has turned into."

Upcoming educational opportunities

2006 SIR meeting, March 30-April 4, Toronto.

Percutaneous tumor ablation: current status and future directions, April 21-22, Boston

Third annual symposium on ablation technologies for urologic cancer, April 28-29, Santa Monica

Fire & Ice 2006 Tumor Ablation Symposium, May 19-20, Las Vegas

Cool-tip Radiofrequency Ablation Master's Course, June 19-20, Rhode Island Hospital, Providence

Endourology and urologic laparoscopy, Oct. 9-10, University of Minnesota campus

For more information about setting up an informal preceptor opportunity with a tumor-ablation expert, contact William McMullen at billmcmullen@cox.net

or call 623/748-3916.